Start Medicare Right
Everything you need to know to Start Medicare Right!
- How much does it cost?
- When does it start?
- What does it cover?
- What are your options?
All of these questions and a few other will be answered below.
Do you have to enroll in Medicare?
Are you receiving your Social Security benefits?
If you started receiving your Social Security benefits before turning 65, you will automatically be enrolled in Medicare Part A and Part B. You should receive your card in the mail from Health & Human Services about 3 months before your 65th birthday.
For most people, Medicare coverage begins the 1st day of the month that you turn age 65.
If you haven’t started receiving your Social Security benefits yet, then you must sign up if you are starting Medicare at age 65. You can do that starting 3 months before you turn 65.
- Local Social Security Office – find yours here
- Online with Social Security – start here
- Phone with Social Security – 1-800-772-1213 from 7 a.m. to 7 p.m. Monday through Friday. If you are deaf or hard of hearing, you can call TTY 1-800-325-0778.
Delaying Medicare or have other coverage?
If you are going to continue working and have insurance from your employer then you may have the option of opting out of Medicare Part until you decide to retire and actually need Medicare coverage.
You can reach out to me if you’re not sure if you should start Medicare or not.
ORIGINAL MEDICARE
Parts A and B make up Original Medicare. You can go to any doctor or hospital that accepts Medicare. And you don’t need a referral to see a specialist.
Medicare Part A is your hospital coverage and Part B is for your medical/doctor coverage.
Most people pay $170.10 per month for this coverage in 2022. But based on your income, it could be higher.
There are some pretty big gaps if you just have Original Medicare. Here’s a few examples:
Hospital Deductible
You are responsible for paying the Medicare Part A deductible if you are admitted to the hospital. In 2022, this is $1,556 dollars. And it’s a unique deductible in that it’s only good for 60 days.
Part B coinsurance
Medicare Part B has a deductible that you are responsible for paying first before your coverage kicks in. The good news is this is a once per year deductible. And it’s much smaller than the hospital deductible. It’s only $233 in 2022.
But after that deductible, Medicare only covers 80%. So you are responsible for paying the other 20%. And this is unique because there is no limit to the 20%.
No matter how big that bill is, you owe 20% of it.
Prescription Drug coverage
Original Medicare does not cover prescription medications. So you need some form of drug coverage to help cover the cost of your medications.
These are 3 very good reasons people need to get something extra for their Medicare coverage. So what can you do?
Overwhelmed by 100 different options?
Most people feel like there’s 100 different options out there. That’s overwhelming trying to decide what’s the right fit for you.
The good news is there’s really just 2 main options.
Medicare Advantage or Medicare Supplement.
Both have pros and cons. Most things in life do. The key thing for you is to know what the pros and cons are for both. That way you can decide which one you prefer based on your priorities.
First up is Medicare Advantage.
Medicare Advantage Plans
Not a Supplement
The first thing I tell people about Medicare Advantage plans is that it’s not a supplement.
This is because it doesn’t work with your Original Medicare. It works instead of it.
You get all your Medicare benefits from an insurance company. You still pay for your Medicare A+B coverage. But you basically put that card in your drawer because you won’t actually use it.
Network based
Medicare Advantage plans use a network. They contract with certain doctors and hospitals that you can go see. If you go out of that network, the plan may not cover anything.
If it’s a life or limb emergency then you would be covered as if it’s in network.
But if you want to go see a specialist who isn’t in network, you may end up paying that entire bill on your own.
Similar to traditional health insurance
Medicare Advantage plans work like traditional health insurance. It’s more of a pay as you go style plan. So if you don’t go to the doctor, you don’t pay very much.
But when you do go, you may have a copay for a regular doctor. Or a higher copay for a specialist. For certain things, you may owe a percentage of the bill.
Your costs are tracked throughout the year because you do have a limit to your exposure.
It’s called a maximum out of pocket. This is your worst case scenario before the insurance company covers 100% for the rest of the year.
For 2021, the most this could be is $7,550 per person. This amount is different for each plan. Most people have options that are lower than that amount. But your options vary based on where you live.
That maximum limit is for in network benefits only. So if you go out of network, it could be higher or have no limit.
All in one $0 plan
You see Medicare Advantage plans advertised on tv as the $0 all in one Medicare plan. The insurance company you choose gets paid by Medicare to provide you your Medicare benefits. So they may not have to charge you anything extra.
But you are still paying for your base Medicare which is $170.10 per month for most people in 2022.
They are considered “all in one” because most plans include prescription drug coverage. And some plans include things like dental and vision coverage too.
Prior Authorizations
A recent study showed that 99% of Medicare Advantage plans include a requirement that you get a prior authorization from the insurance company before something is covered.
Not all treatments require a prior authorization.
But it’s important to know that this is a hoop you may need to jump through BEFORE you get certain treatments done.
Medicare supplement aka Medigap
Monthly Premium
With Medicare supplements you pay an extra premium to help pay what Medicare doesn’t pay. Typically you are looking at an extra $100 to $120 per month in additional premium.
No copays
This will help pay the hospital deductible for you. So if you are admitted to a hospital, this coverage works with your Original Medicare to pay that $1,556 on your behalf. So you pay $0.
The most comprehensive Medigap plan that most people can buy in 2020 or later is very comprehensive. One thing is can’t cover is your Medicare Part B deductible which is $233 in 2022.
But it does help pay the 20% that Medicare doesn’t cover. So if you are sick or injured and need to use your plan then you would be responsible for the first $233 this year. After that, Medicare covers 80% and the supplement covers the other 20%. That means you have no copays or any medical bills.
No Networks
A Medicare supplement keeps you on Original Medicare. Which means there are no networks. So you can see any doctor nationwide.
The only question you need to ask is if they accept Medicare. And 97% of doctors accept Medicare. So you have a lot more flexibility to go where you want to go for your treatment.
A la carte coverage
Medicare supplements are considered a la carte coverage. Because the Medicare supplement helps cover the gaps in A+B coverage. But it doesn’t help with your drug coverage.
So I will look at which medications you need covered, and what pharmacy you want to use. Then compare the plans to find the lowest total cost plan for you. The average drug plan nationally is about $30 per month. But many people I work with pay less than that.
Dental and vision is also optional coverage we can add.
Limited window for guaranteed approval
When you first start Medicare, there is a limited time period where you are guaranteed to be approved for any plan that you want from any company that you want. After that window is over, you need to pass a health review if you want to change plans.
So if you start with a Medicare Advantage plan and 2 years down the road decide you want to pay the extra premium for the extra coverage with a Medicare supplement you need to pass a health review.
Based on your health history, the insurance company can say:
- Yes, we accept you
- We, accept you but are going to charge you more
- No, we don’t want to offer you coverage
If you start with a Medicare supplement, you can switch to a Medicare Advantage plan later because Advantage plans do NOT ask health questions.
Check this out if you are in Wisconsin and want to know more about your Wisconsin Medicare supplement options.
If your in a different state then this is what you need to know about the best Medicare supplement options.
PRESCRIPTION DRUG COVERAGE
Part D – Prescription Drug Coverage
Medicare requires you to have creditable prescription coverage or you could face if you enroll later.
Many Advantage plans include prescription drug coverage built right into the health plan. Or you can get a standalone drug plan.
They all follow the same basic template. In general, there is a tiering system. Most plans have 5 tiers of medications. In general, the lower the tier means the lower the cost of the medication.
Drug plans are sold by insurance companies. They must be approved by Medicare in order to offer those plans. Part of that approval means they have to meet a minimum standard. They could be better than that minimum standard but Medicare requires them to be at least meeting that standard.
I will do a comparison of all the Medicare Part D/Prescription Drug Plans available based on the medications you need covered and the pharmacy you want to use. These are the 2 biggest impacts for which plan to choose. Based on that info we will review the lowest total cost plan for you.
What’s more appealing to you?
Do you prefer a Medicare Advantage plan? Or the Medicare supplement/Medigap with a drug plan option?
That’s the biggest question people that work with me have to answer. After that, I make everything extremely easy for you.
Working with Medicare Mike?
I’m an independent insurance broker that works with Medicare Advantage, Medicare Supplement, and Prescription Drug plans.
Whichever one you prefer, I can help you shop.
I work with a bunch of companies. You don’t pay me anything. You don’t pay anything extra for using me. If you enroll through me, then the insurance company pays me a commission. Otherwise they just list an internal agent on your application and keep the commission.
And if you ever have a question or issue, you can call me. I work on your behalf and talk with the companies so you don’t have to.
Call me at 855-712-7316, email me at Mike@askMedicareMike.com or fill out the form below so set up a time for us to talk and review your situation.